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� 0 -(�, 28 -S <br />Date_ 4-23- 2 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only T(I PA17TI NG 4-1i�11- <br />>2 <br />Puplw: Woe.a P.rmu /(17 <br />elan Dept . 16489 <br />Puhk Wo,ko roe <br />Total roe - <br />Lee. appt Fee PeUd <br />B.hnC. Due $ <br />Norkri Corp 7114 212th St SE Woodinville 98072 481-8467 <br />Owner Mailing Address City Zip Phone <br />Owner <br />Appiteant Mailing Address City Zip Phone <br />Describe Proposed Work <br />W <br />Project Address (if known) 1121 61rd St SE <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable <br />t� <br />• Property Lines • Centerline of street <br />/^ <br />• Outline and d.mensions of all existing and • Indicate North <br />v♦ <br />proposed structures on the lot • Show any proposed grading eta non. <br />• Exlsling and proposed utilities • Show measurements <br />s <br />DO NOT WRITE BELOW THIS LINE <br />O <br />PERMIT CONDITIONS iiJuu381yF3 <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design, and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />O <br />O <br />ow <br />of <br />Apprdved for <br />Coonnnss/trr Ions//J Date <br />S' L <br />FINAL INSPECTION Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />ML3200 <br />Cedar Street <br />NNITIFIFT <br />Everett WA 98201 <br />Phone:259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to holy and save harr T- <br />less the City of Everett from any and all claims for damages, costs <br />expenses. or causes of action that may arise because of installation, <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Qnature of Applicant Date <br />WORK AUTHO BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCe1LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJLCT OVER 90 DAYS DURATION. <br />